OBJECTIVES: Approximately 60% of people with diabetes experience non-severe hypoglycemic events, the most troubling of which are non-severe nocturnal events (NSNHE).  Unfortunately, little is known about the specific impacts of NSNHEs on functioning, well-being and diabetes management. METHODS: Nine focus groups were conducted in the US and Europe (France, Germany, UK). Transcriptions were coded based on modified grounded theoretical approach and a theoretical model of the impact of NSNHEs derived. RESULTS: Seventy-seven people participated: mean age 46.5 (20 to 65), (26 type 1, 51 type 2), 66.2% on insulin with on average 4.1 (range 1-25) NSNHEs per month. Analysis generated domains of: symptoms, corrective diabetes management actions taken, sleep disruption, social and work impacts. Participants reported awakening with sweating, shaking, dizziness, odd dreams, and vision disturbances. The majority of participants noted difficulty in returning to sleep following the NSNHE and many did not return to sleep for the remainder of the night. As a result, most participants reported feeling fatigue and being physically ill (e.g. headaches) the next day, negatively impacting a wide range of daily activities. This impact lasted well into the next day and sometimes for as much as 48 hours.  Corrective actions often included a reduction in insulin dose and increased blood glucose monitoring in subsequent days.  At work, participants reported calling in sick, arriving late, concentration problems, or reduced effort. They described canceling social event and coping with irritability that affected their interactions with family and friends. Additionally, sleep quality of partners was also disrupted due to the event.  NSNHEs were considered by most to be more frightening, dangerous and anxiety provoking than daytime events. Findings were similar across all countries. CONCLUSIONS:  NSNHEs have a significant negative impact and require further study. Reducing their frequency may help improve diabetes management and patient quality of life.